Yesterday the country reflected on our veterans and their service to our democracy on Veterans’ Day. At the North Carolina Medical Society’s (NCMS) recent Annual Meeting, a variety of experts addressed the health care issues that face some veterans and how physicians and physician assistants can be of service to our service men and women.

Michael Brennan, MD, himself a veteran and longtime NCMS member, moderated a CME panel on “Quality Care for Veterans.”

First, Elizabeth Goolsby, Director of the Fayetteville VA Medical Center, set the stage and made it clear that many doctors likely are caring for veterans and they may not even know it. There are 800,000 veterans in North Carolina and that number is growing by about 4 percent a year. The youngest is 19 years old and the oldest is 105. Approximately 75 percent of veterans are combat vets and 85 percent are male. However, last year 106 babies were born to female vets in the area served by Fayetteville VA.

Goolsby spoke of the Veterans Care Act recently passed by Congress, which assures veterans of care within 30 days and within 40 miles of their home. The need for more “community providers” or doctors otherwise unaffiliated with the VA is increasing. She said telemedicine also is used. The goal is to provide care to veterans “unhampered by time or distance.”

Glenn Batten, Deputy Director of the North Carolina Division of Veterans Affairs, outlined the resources available for veterans throughout the state and the various forms of health insurance for which they may be eligible. In general, reimbursement for community providers is about the same as Medicare. He encouraged doctors and their veteran patients to access the information and necessary resources for individuals by calling 844-NC4-VETS or visit www.NC4VETS.com, which just launched yesterday, on Veterans’ Day.

Debra Bolick, MD, a psychiatrist at the VA Medical Center in Salisbury, an NCMS member and a member of the North Carolina Medical Board, spoke about mental health issues involving veterans.

“Being a vet may change a patient’s course of treatment,” she said. Having come to the VA after working in private practice, she said she has learned more about how “to speak their language” and to be alert to symptoms of post-traumatic stress disorder (PTSD) that was precipitated by combat experiences. She said that 20 percent of Iraq and Afghanistan veterans have PTSD and usually have substance abuse problems that accompany it.

Brian Hayes, MD, MPH, MSS, the Associate Chief of Staff, Ambulatory Care at the Durham VA Medical Center, stressed that civilian doctors should not be afraid to ask their patients about military service, because it may indeed impact their treatment. He estimated that one in 10 patients seen by a typical physician in North Carolina likely is a veteran. He suggested opening lines of communication by simply asking the patient if it would be OK to ask about their military experience. If the patient agrees, a wealth of information may be gathered about injuries, exposure to harmful substances like chemical or biological weapons or readjusting to civilian life.

“Each scar has a story,” Hayes said, adding that doctors should let the patient take the lead on what and how much to reveal about their experiences in the military, since some may be too painful to recall.